Interactions
In patients taking blood thinners from the group of vitamin K antagonists (coumarins) such as Marcumar ® (phenprocoumon), for example, a dose adjustment in the sense of a reduction may be necessary, since therapy with Tramal ® may result in an even greater tendency to bleed, which is shown in the laboratory as a further drop in the Quick value or increase in the INR value. The anti-nausea drug ondansetron from the group of serotonin receptor antagonists can inhibit the analgesic effect of tilidine, as can carbamazepine, which is used to treat epilepsy, mania and neuropathic pain.
Dosage
The single dose of Tramal® drops can be 20-40 drops, often 30 drops are prescribed by the doctor as a single dose. 20 drops of Tramal® contain 50 mg tramadol. The maximum daily dose is 400 mg, as with tablets and hard capsules, corresponding to 160 drops. Accordingly, a maximum of 40 drops can be taken in the morning, at noon, in the evening and at night.
ApplicationIndication
Tramal® drops are used in the same way as tablets to treat moderate to severe pain. They are therefore used in stage 2 of the WHO 3-stage pain therapy scheme and can be combined with WHO stage 1 painkillers such as indomethacin, ibuprofen, paracetamol or metamizole (Novalgin®). A combination of low-potency opioids such as Tramal® with high-potency opioids such as Fentanyl should be avoided, as their pain-relieving effect is mutually inhibitory.
Contraindications
In the case of acute intoxication with sleeping pills, alcohol, antidepressants or other drugs from the opioid group, as well as intoxication with heroin (one of the opioids), Tramal® must not be taken, as the attenuating and respiratory depressive effect is significantly increased and can lead to respiratory and circulatory arrest. Furthermore, Tramal® must not be taken if a therapy with MAO inhibitors for the treatment of depression is carried out, as the risk of serotonin syndrome is significantly increased in this case. MAO-inhibitors must be discontinued for at least 14 days before therapy with Tramal®.Simultaneous therapy with Tramal® and antidepressants from the group of selective serotonin reuptake inhibitors (SSRIs), such as citalopram or fluoxetine, carries an equal risk.
Combination therapy should therefore be carried out under the strictest indication and with the greatest caution and regular monitoring. Tramal ® should not be used in patients with epilepsy that is not well controlled by medication, as the risk of seizures is increased. Other relative contraindications (use of Tramal ® not absolutely contraindicated but with great caution) are disturbances of consciousness, respiratory disorders, conditions with increased intracranial pressure and marked renal or hepatic failure.
The use of Tramal® during pregnancy and lactation is not absolutely contraindicated, single doses can be given relatively safely. Nevertheless, the indication should be carefully considered. Long-term therapy with Tramal® during pregnancy and lactation should be avoided, as the child may become accustomed to the active substance, which may result in withdrawal symptoms after birth or during the lactation period. In senile patients (over 75 years of age) the excretion of Tramal® may be prolonged, so that the dose has to be adjusted in the sense of a reduction.
